Connecting the clinical IT infrastructure to a service-oriented architecture of medical devices

Ten Topics to Get Started in Medical Informatics Research

The vast and heterogeneous data being constantly generated in clinics can provide great wealth for patients and research alike. The quickly evolving field of medical informatics research has contributed numerous concepts, algorithms, and standards to facilitate this development. However, these difficult relationships, complex terminologies, and multiple implementations can present obstacles for people who want to get active in the field. With a particular focus on medical informatics research conducted in Germany, we present in our Viewpoint a set of 10 important topics to improve the overall interdisciplinary communication between different stakeholders (eg, physicians, computational experts, experimentalists, students, patient representatives). This may lower the barriers to entry and offer a starting point for collaborations at different levels. The suggested topics are briefly introduced, then general best practice guidance is given, and further resources for in-depth reading or hands-on tutorials are recommended. In addition, the topics are set to cover current aspects and open research gaps of the medical informatics domain, including data regulations and concepts; data harmonization and processing; and data evaluation, visualization, and dissemination. In addition, we give an example on how these topics can be integrated in a medical informatics curriculum for higher education. By recognizing these topics, readers will be able to (1) set clinical and research data into the context of medical informatics, understanding what is possible to achieve with data or how data should be handled in terms of data privacy and storage; (2) distinguish current interoperability standards and obtain first insights into the processes leading to effective data transfer and analysis; and (3) value the use of newly developed technical approaches to utilize the full potential of clinical data.

Proposing an International Standard Accident Number for Interconnecting Information and Communication Technology Systems of the Rescue Chain

BACKGROUND

The rapid dissemination of smart devices within the internet of things (IoT) is developing toward automatic emergency alerts which are transmitted from machine to machine without human interaction. However, apart from individual projects concentrating on single types of accidents, there is no general methodology of connecting the standalone information and communication technology (ICT) systems involved in an accident: systems for alerting (e.g., smart home/car/wearable), systems in the responding stage (e.g., ambulance), and in the curing stage (e.g., hospital).

OBJECTIVES

We define the International Standard Accident Number (ISAN) as a unique token for interconnecting these ICT systems and to provide embedded data describing the circumstances of an accident (time, position, and identifier of the alerting system).

MATERIALS AND METHODS

Based on the characteristics of processes and ICT systems in emergency care, we derive technological, syntactic, and semantic requirements for the ISAN, and we analyze existing standards to be incorporated in the ISAN specification.

RESULTS

We choose a set of formats for describing the embedded data and give rules for their combination to generate an ISAN. It is a compact alphanumeric representation that is generated easily by the alerting system. We demonstrate generation, conversion, analysis, and visualization via representational state transfer (REST) services. Although ISAN targets machine-to-machine communication, we give examples of graphical user interfaces.

CONCLUSION

Created either locally by the alerting IoT system or remotely using our RESTful service, the ISAN is a simple and flexible token that enables technological, syntactic, and semantic interoperability between all ICT systems in emergency care.

Development of the Joint Commission of Taiwan's Smart Healthcare Standard

It is well known that information technology (IT) can play a pivotal role in enhancing healthcare quality and patient safety. The use of computational science to enhance the capabilities of hospital information systems helps deliver enhanced healthcare quality. "Smart healthcare" has become a popular term, reflecting the level of IT involvement in healthcare services. However, each hospital has a different level of IT development, and no clear definition of smart healthcare exists. In this study, we aimed to develop and validate a survey standard to evaluate the level of IT involvement in hospitals. The quality improvement task force of the Joint Commission of Taiwan (QITF-JCT) conducted a systematic literature review to identify the key elements of major healthcare IT functions. The modified Delphi technique was used to review the importance and appropriateness of these elements through an expert panel, and the JCT Smart Healthcare Standard version 1.0 (JCT-SHS 1.0) was drafted. A total of 40 healthcare quality improvement campaign (HQIC) application projects in 2018 were selected for evaluating nine key dimensions of hospital functions: security, digitization, automation, interconnection, connectivity, interoperability, mobility, computation, and artificial intelligence. The standard can be used smart hospital evaluation and executed by two experts by on-site evaluation and rating as three-level scale (norm, excellent, and innovative). The internal consistency and inter-rater reliability were investigated using Cronbach's α and kappa statistics, respectively. This standard was evaluated by using 40 HQIC application projects. The Cronbach's α values were in the range of 0.74-0.92, indicating the good internal consistency of the JCT-SHS 1.0 among the nine IT dimensions. The kappa correlation coefficients were 0.68 for security (p = 0.027), 0.47 for digitization (p = 0.042), 0.21 for automation (p = 0.048), 0.82 for interconnection (p = 0.014), 0.35 for connectivity (p = 0.036), 0.28 for interoperability (p = 0.042), 0.71 for mobility (p = 0.016), 0.47 for computation (p = 0.029), and 0.34 for artificial intelligence (p = 0.033), revealing moderate inter-rater reliability. The validation data indicated that the JCT-SHS 1.0 is a consistent and reliable instrument for evaluating the levels of IT development in the hospitals. Healthcare providers, external accreditation bodies, and policymakers may use the JCT-SHS 1.0 to assess and plan their organizational and system-wise IT strategy.

Extending BPMN 2.0 for intraoperative workflow modeling with IEEE 11073 SDC for description and orchestration of interoperable, networked medical devices

PURPOSE

Surgical workflow management in integrated operating rooms (ORs) enables the implementation of novel computer-aided surgical assistance and new applications in process automation, situation awareness, and decision support. The context-sensitive configuration and orchestration of interoperable, networked medical devices is a prerequisite for an effective reduction in the surgeons' workload, by providing the right service and right information at the right time. The information about the surgical situation must be described as surgical process models and distributed to the medical devices and IT systems in the OR. Available modeling languages are not capable of describing surgical processes for this application.

METHODS

In this work, the BPMN^SIX modeling language for intraoperative processes is technically enhanced and implemented for workflow build-time and run-time. Therefore, particular attention is given to the integration of the recently published IEEE 11073 SDC standard family for a service-oriented architecture of networked medical devices. In addition, interaction patterns for context-aware configuration and device orchestration were presented.

RESULTS

The identified interaction patterns were implemented in BPMN^SIX for an ophthalmologic use case. Therefore, the examples of the process-driven incorporation and control of device services could be demonstrated.

CONCLUSION

The modeling of surgical procedures with BPMN^SIX allows the implementation of context-sensitive surgical assistance functionalities and enables flexibility in terms of the orchestration of dynamically changing device ensembles and integration of unknown devices in the surgical workflow management.

Evaluation of an Anesthesia Dashboard Functional Model Based on a Manufacturer-Independent Communication Standard: Comparative Feasibility Study

Background

Current anesthesia workspaces consist of several technical devices, such as patient monitors, anesthesia machines, among others. Commonly, they are produced by different manufacturers; thus, they differ in terms of their modus operandi, user interface, and representation of alarms. Merging the information from these devices using a single joint protocol and displaying it in a single graphical user interface could lead to a general improvement in perioperative management. For this purpose, the recently approved and published Institute of Electrical and Electronics Engineers 11073 service-oriented device connectivity standard was implemented.

Objective

This paper aims to develop and then evaluate an anesthesia workstation (ANWS) functional model in terms of usability, fulfillment of clinical requirements, and expected improvements in patient safety.

Methods

To compare the self-developed ANWS with the conventional system, a pilot observational study was conducted at the University Hospital Aachen, Germany. A total of 5 anesthesiologists were asked to perform different tasks using the ANWS and then the conventional setup. For evaluation purposes, response times were measured and an interaction-centered usability test with an eye-tracking system was carried out. Finally, the subjects were asked to fill in a questionnaire in order to measure user satisfaction.

Results

Response times were significantly higher when using the ANWS, but decreased considerably after one repetition. Furthermore, usability was rated as excellent (≥95) according to the System Usability Scale score, and the majority of clinical requirements were met.

Conclusions

In general, the results were highly encouraging, considering that the ANWS was only a functional model, as well as the lack of training of the participants. However, further studies are necessary to improve the universal user interface and the interplay of the various networked devices.

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

BACKGROUND

Hospital at home (HaH) is a model of care that provides acute-level services in the home. HaH has been shown to improve quality and patient satisfaction, and reduce iatrogenesis and costs. Uptake of HaH in the United States has been limited, and little research exists on how to implement it successfully.

OBJECTIVES

This study examined facilitators and barriers to implementation of an HaH program.

DESIGN

A HaH program that included a 30-day transitional care bundle following the acute stay was implemented through a Centers for Medicare & Medicaid Services Innovations Award. Informants completed a priming table describing initial implementation components, their barriers, and facilitators. These were followed up with semistructured focus groups and individual interviews that were transcribed and independently coded using thematic analysis by two independent investigators.

SETTING

Large urban academic health system.

PARTICIPANTS

Clinical and administrative personnel from Mount Sinai, the Visiting Nurse Service of New York, and executive leaders at partner organizations (laboratory, pharmacy, radiology, and transportation).

RESULTS

To facilitate successful development and implementation of a high-quality HaH program, a number of barriers needed to be overcome through significant teamwork and communication internally with policymakers and external partners. Areas of paramount importance include facilitating work-arounds to regulatory barriers and health system policies; altering an electronic health record that was not designed for HaH; developing the necessary payment and billing mechanisms; and building effective and collaborative partnerships and communication with outside vendors.

CONCLUSION

Development of HaH programs in the United States are feasible but require strategic planning and development of strong, tightly coordinated partnerships. J Am Geriatr Soc 67:588-595, 2019.

On the Way to Close the Loop in Information Logistics: Data from the Patient - Value for the Patient

OBJECTIVE

 To summarize recent research and to propose a selection of best papers published in 2017 in the field of Clinical Information Systems (CIS).

METHOD

 Each year a systematic process is carried out to retrieve articles and to select a set of best papers for the CIS section of the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. The query aiming at identifying relevant publications in the field of CIS was refined by the section editors during the last years. For three years now, the query is stable. It comprises search terms from the Medical Subject Headings (MeSH) thesaurus as well as additional free text search terms from PubMed and Web of Science^®. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results, the best papers were then selected by the IMIA Yearbook editorial board. Text mining, and term co-occurrence mapping techniques were used to get an overview on the content of the retrieved articles.

RESULTS

 The query was carried out in mid-January 2018, yielding a consolidated result set of 2,255 articles which had been published in 939 different journals. Out of them, 15 papers were nominated as candidate best papers and four of them were finally selected as best papers in the CIS section. Again, the content analysis of the articles revealed the broad spectrum of topics which is covered by CIS research.

CONCLUSIONS

 Modern clinical information systems serve as backbone for a very complex, trans-institutional information logistics process. Data that is produced by, documented in, shared via, organized in, presented by, and stored within clinical information systems is more and more reused for multiple purposes. We found a lot of examples showing the benefits of such data reuse with various novel approaches implemented to tackle the challenges of this process. We also found that the patient moves in the focus of interest of CIS research. So the loop of information logistics begins to close: data from the patients is used to produce value for the patients.